Research Papers on Childhood Obesity
Childhood obesity is a problem in a number of countries around the world. A few may agree that the United States is the leader in having too many children being considered overweight. The problem is becoming an epidemic since there are a number of issues that need to be tackled. Various research papers may look at how this problem should be solved, while others may look at solutions that have been developed but could use a few changes. Overall, research papers help us understand the issue in a deeper capacity. Many of us just hope the problem can be solved sooner than later.
The following points are just a few areas in which childhood obesity has been researched. A few of these points may need further investigation or prove to be an area of interest for future research paper content.
- Exploring common reasons why childhood obesity is a problem. Many people feel children eat too much food, have poor diets that lack fruits and veggies, or don’t exercise enough during the day. This may be true, but each reason has other reasons behind it making the problem more complex.
- Parents may not be encouraging their children as much as they should. Meaning, some parents may not realize they are being a role model in how their child eats. Parents can set examples by eating healthy themselves or help their child learn to cut portions of certain types of foods. Aside from good eating and snacking habits, exercise and physical activity is another point of concern. Some parents may not be doing enough of this either.
- When obesity runs in the family or is related to a health condition. In some cases, children who are overweight may not be able to help themselves or it may not necessarily be their fault. Sometimes a hormonal imbalance may be to blame or certain medications may add on the pounds.
- Childhood obesity may cause other health problems making it more difficult to experience weight loss.
Children who are considered overweight may find it challenging to lose weight or keep it off if they have a health condition such as juvenile diabetes or issues with their thyroid. In such cases, parents need to help children understand their options in achieving better health. This may include consulting a dietitian or physician who specializes in treating overweight children.
Investigating the causes of childhood obesity, determining what to do about them, and taking appropriate action must address the variables that influence both eating and physical activity. Seemingly straightforward, these variables result from complex interactions across a number of relevant social, economic, cultural, environmental, and policy contexts.
U.S. children live in a society that has changed dramatically in the three decades over which the obesity epidemic has developed. Many of these changes, such as both parents working outside the home, often affect decisions about what children eat, where they eat, how much they eat, and the amount of energy they expend in school and leisure time activities (Ebbeling et al., 2002; Hill et al., 2003).
Other changes, such as the increasing diversity of the population, influence cultural views and marketing patterns. Lifestyle modifications, in part the result of media usage and content together with changes in the physical design of communities, affect adults' and children's levels of physical activity. Many of the social and cultural characteristics that the U.S. population has accepted as a normal way of life may collectively contribute to the growing levels of childhood obesity. The broad societal trends that impact weight outcomes are complex and clearly multifactorial. With such societal changes, it is difficult to tease out the quantitative and qualitative role of individual contributing factors. While distinct causal relationships may be difficult to prove, the dramatic rise in childhood obesity prevalence must be viewed within the context of these broad societal changes.
An understanding of these contexts, particularly regarding their potential to be modified and how they may facilitate or impede development of a comprehensive obesity prevention strategy, is therefore essential. This next section provides a useful background to understand the multidimensional nature of the childhood obesity epidemic.
Lifestyle and Demographic Trends
The interrelated areas of family life, ethnic diversity, eating patterns, physical activity, and media use—discussed below—are all aspects of societal change that must be considered. Singly and in concert, the trends in these areas will strongly influence prospects for preventive and corrective measures.
The changing context of American families includes several distinct trends such as the shifting role of women in society, delayed marriage, childbearing outside of marriage, higher divorce rates, single parenthood, and work patterns of parents (NRC, 2003). Among the many important transformations that have occurred are expanded job opportunities for women, which have led to more women entering the workforce. Economic necessities have also prompted this trend. Moreover, married mothers are increasingly more likely than they were in the past to remain in the labor force throughout their childbearing years.
Women's participation in the labor force increased from 36 percent in 1960 to 58 percent in 2000 (Luckett Clark and Weismantle, 2003). Since 1975, the labor force participation rate of mothers with children under age 18 has grown from 47 to 72 percent, with the largest increase among mothers with children under 3 years of age (U.S. Department of Labor, 2004). Over the same period, men's labor force participation rates declined slightly from 78 percent to 74 percent (Population Reference Bureau, 2004b). In 2002, only 7 percent of all U.S. households consisted of married couples with children in which only the husband worked.
These trends, together with lower fertility rates, a decrease in average household size, and the shift in household demographics from primarily married couples with children to single person households and households without children, have caused the number of meal preparers in U.S. households who cook for three or more people to decline (Population Reference Bureau, 2003; Sloan, 2003).
It has been suggested that smaller households experience fewer economies of scale in home preparation of meals than do larger families. Preparing food at home involves a set amount of time for every meal that changes minimally with the number of persons served. Eating meals out involves the same marginal costs per person. Moreover, changes in salary and the lower prices of prepared foods may have reduced the value of time previously used to prepare at-home meals. Thus, incentives have been shifted away from home production toward eating more meals away from home (Sturm, 2004). Time-use trends for meal preparation at home reveal a gradual decline from 1965 to 1985 (44 minutes per day versus 39 minutes per day) and a steeper decline from 1985 to 1999 (39 minutes per day versus 32 minutes per day) (Robinson and Godbey, 1999; Sturm, 2004).
The racial and ethnic composition of children in the United States is becoming more diverse. In 2000, 64 percent of U.S. children were white non-Hispanic, 15 percent were black non-Hispanic, 4 percent were Asian/Pacific Islander, and 1 percent were American Indian/Alaska Native. The proportion of children of Hispanic origin has increased more rapidly than the other racial and ethnic groups from 9 percent of the child population in 1980 to 16 percent in 2000 (Federal Interagency Forum on Child and Family Statistics, 2003).
Differences among ethnic groups (e.g., African American, American Indian, Hispanic, and Asian/Pacific Islanders) include variations in household composition and size—particularly larger household size in Hispanic and Asian populations (Frey, 2003)—and in other aspects of family life such as media use and exposure, consumer behavior, eating, and physical activity patterns (Tharp, 2001; Nesbitt et al., 2004).
Ethnic minorities are projected to comprise 40.2 percent of the U.S. population by 2020 (U.S. Census Bureau, 2001), and the food preferences of ethnic families are expected to have a significant impact on consumers' food preferences and eating patterns (Sloan, 2003). The higher-than-aver-age prevalence of obesity in several ethnic minority populations may indicate differences in susceptibility to unfavorable lifestyle trends and the consequent need for specially designed preventive and corrective strategies (Kumanyika, 2002; Nesbitt et al., 2004).
As economic demands and the rapid pace of daily life increasingly constrain people's time, food trends have been marked by convenience, shelf stability, portability, and greater accessibility of foods throughout the entire day (Food Marketing Institute, 1996, 2003; French et al., 2001; Sloan, 2003). Food has become more available wherever people spend time. Because of technological advances, it is often possible to acquire a variety of highly palatable foods, in larger portion sizes, and at relatively low cost. Research has revealed a progressive increase, from 1977 to 1998, in the portion sizes of many types of foods and beverages available to Americans (Nielsen and Popkin, 2003; Smiciklas-Wright et al., 2003); and the concurrent rise in obesity prevalence has been noted (Nestle, 2003; Rolls, 2003).
Foods eaten outside the home are becoming more important in determining the nutritional quality of Americans' diets, especially for children (Lin et al., 1999b; French et al., 2001). Consumption of away-from-home foods comprised 20 percent of children's total calorie intake in 1977-1978 and rose to 32 percent in 1994-1996 (Lin et al., 1999b). In 1970, household income spent on away-from-home foods accounted for 25 percent of total food spending; by 1999, it had reached nearly one-half (47 percent) of total food expenditures (Clauson, 1999; Kennedy et al., 1999).
The trend toward eating more meals in restaurants and fast food establishments may be influenced not only by simple convenience but also in response to needs such as stress management, relief of fatigue, lack of time, and entertainment. According to a 1998 survey conducted by the National Restaurant Association, two-thirds of Americans indicated that patronizing a restaurant with family or friends allowed them to socialize and was a better use of their leisure time than cooking at home and cleaning up afterward (Panitz, 1999).
For food consumed at home, never has so much been so readily available to so many—that is, to virtually everyone in the household—at low cost and in ready-to-eat or ready-to-heat form (French et al., 2001; Sloan, 2003). Increased time demands on parents, especially working mothers, have shifted priorities from parental meal preparation toward greater convenience (French et al., 2001), and the effects of time pressures are seen in working mothers' reduced participation in meal planning, shopping, and food preparation (Crepinsek and Burstein, 2004). Industry has endeavored to meet this demand through such innovations as improved packaging and longer shelf stability, along with complementary technologies, such as microwaves, that have shortened meal preparation times.
Another aspect of this trend toward convenience is an increased prevalence, across all age groups of children and youth, of frequent snacking and of deriving a large proportion of one's total daily calories from energy-dense snacks (Jahns et al., 2001). At the same time, there has been a documented decline in breakfast consumption among both boys and girls, generally among adolescents (Siega-Riz et al., 1998) and in urban elementary school-age children as compared to their rural and suburban counterparts (Gross et al., 2004); further, children of working mothers are more likely to skip meals (Crepinsek and Burstein, 2004).
There are also indications that children and adolescents are not meeting the minimum recommended servings of five fruits and vegetables daily recommended by the Food Guide Pyramid (Cavadini et al., 2000; American Dietetic Association, 2004). This trend is partially explained by the limited variety of fruits and vegetables consumed by Americans. In 2000, five vegetables—iceberg lettuce, frozen potatoes, fresh potatoes, potato chips, and canned tomatoes—accounted for 48 percent of total vegetable servings and six fruits (out of more than 60 fruit products)—orange juice, bananas, apple juice, apples, fresh grapes, and watermelon—accounted for 50 percent of all fruit servings (Putnam et al., 2002).
These trends have contributed to an increased availability and consumption of energy-dense foods and beverages. As summarized in Table 1-1 and Figures 1-1 through 1-3, trends in the dietary intake of the general U.S. population parallel trends in the dietary intake of children and youth. A more in-depth discussion of caloric intake, energy balance, energy density, Dietary Guidelines for Americans, and the Food Guide Pyramid is included in Chapters 3, 5, and 7.
Trends in Food Availability and Dietary Intake of the U.S. Population and of U.S. Children and Youth.
U.S. macronutrient food supply trends for carbohydrates, protein, and total fat, 1970-2000. SOURCES: Putnam et al., 2002; USDA, 2003.
Percentage of calories from macronutrient intake for carbohydrates, protein, and total fat among adult men and women, 1970-2000. SOURCE: CDC, 2004a.
Available calories from the U.S. food supply, adjusted for losses,a and average energy intake for adult men and women,b 1970-2000. a Based on USDA food supply data, calories from the U.S. food supply adjusted for spoilage, cooking losses, plate waste, (more...)
Physical activity is often classified into different types including recreational or leisure time, utilitarian, household, and occupational. The direct surveillance of physical activity trends in U.S. adults began only in the 1980s and was limited to characterizing leisure-time physical activity. In 2001, CDC began collecting data on the overall frequency and duration of time spent in household, transportation, and leisure-time activity of both moderate and vigorous intensity in a usual week through the state-based Behavioral Risk Factor Surveillance System (BRFSS) (CDC, 2003c).
National surveys conducted over the past several decades suggest an increase in population-wide physical activity levels among American men, women, and older adolescents; however, a large proportion of these populations still do not meet the federal guidelines for recommended levels of total daily physical activity.3 The data for children's and youth's leisure time and physical activity levels reveal a different picture than the adult physical activity trend data that are summarized in Table 1-2.
Trends in Leisure Time and Physical Activity of U.S. Adults, Children, and Youth.
Trend data collected by the Americans' Use of Time Study, through time-use diaries, indicated that adults' free time increased by 14 percent between 1965 and 1985 from 35 hours to an average total of nearly 40 hours per week (Robinson and Godbey, 1999). Data from other population-based surveys, including the National Health Interview Survey, National Health and Nutrition Examination Survey (NHANES), BRFSS, and the Family Interaction, Social Capital and Trends in Time Use Data (1998-1999), together with trend data on sports and recreational participation, suggest minor to significant increases in reported leisure-time physical activity among adults (Pratt et al., 1999; French et al., 2001; Sturm, 2004).
Data from the 1990-1998 BRFSS4 revealed only a slight increase in self-reported physical activity levels among adults (from 24.3 percent in 1990 to 25.4 percent in 1998), and a decrease in respondents reporting no physical activity at all (from 30.7 percent in 1990 to 28.7 percent in 1998) (CDC, 2001).
Women, older adults, and ethnic minority populations have been identified as having the greatest prevalence of leisure-time physical inactivity (CDC, 2004b). In general, the prevalence of self-reported, no leisure-time physical activity was highest in 1989, and declined to its lowest level in 15 years among all groups in 35 states and the District of Columbia based on BRFSS data, although it is unclear why this occurred (CDC, 2004b). In 2001, BRFSS respondents were asked to report the overall frequency and duration of time spent in household, transportation, and leisure-time activity of both moderate and vigorous intensity (CDC, 2003c). Although 45.4 percent of adults reported having engaged in physical activities consistent with the recommendation of a minimum of 30 minutes of moderate intensity activity on most days of the week in 2001, more than one-half of U.S. adults (54.6 percent) were not sufficiently active to meet these recommendations (CDC, 2003c).
The physical activity trend data for children and youth are even more limited than for adults. Most available information is on the physical activity levels of high school youth, with limited data available on levels in younger children. Based on the Youth Risk Behavior Survey (YRBS), daily enrollment in physical education classes declined among high school students from 42 percent in 1991 to 25 percent in 1995 (DHHS, 1996) and increased slightly to 28.4 percent in 2003 (CDC, 2004c). Cross-sectional data collected through the YRBS for 15,214 high school students indicated that one-third (33.4 percent) of 9th to 12th graders nationwide are not engaging in recommended levels of moderate or vigorous physical activity and an estimated 10 percent report that they are inactive (CDC, 2003b, 2004c; see Chapter 7).
In 2002, the CDC collected baseline data through the Youth Media Campaign Longitudinal Survey (YMCLS), a nationally representative survey of children aged 9 to 13 years and their parents, which revealed that 61.5 percent of youth in this age group do not participate in any organized physical activity during their nonschool hours and 22.6 percent do not engage in any free-time physical activity (CDC, 2003a).
Shifts in transportation patterns can affect energy balance. Many technological innovations have occurred over the past several decades such as the increased availability of labor-saving devices in the home, a decline in physically active occupations, and the dominance of automobiles for commuting to work and personal travel (Cutler et al., 2003). National data tracking trends on the physical activity levels and leisure or discretionary time of younger children and pre-adolescents are limited. However, an analysis of the available data for children aged 3 to 12 years from 1981 to 1997 (Hofferth and Sandberg, 2001) suggests a decline in their free time by six hours per week—attributed to an increase in time away from home in structured settings—and an increase in time spent in organized sports and outdoor activities over this time frame (Sturm, 2005a). However, it is not possible to determine the overall impact of these changes on children's physical activity levels.
One factor that has influenced overall transportation patterns in the United States is the change in the built environment. Through a number of mediating factors, the built environment can either promote or hinder physical activity, although the role and influence of the built environment on physical activity levels is a relatively new area of investigation. The ways in which land is developed and neighborhoods are designed may contribute to the level of physical activity residents achieve as a natural part of their daily lives (Frank, 2000).
There have been many changes in the built environment over the past century or more. For a variety of reasons, Americans moved away from central cities to lower density suburbs, many of the most recent of which necessitate driving for transportation.
In these areas, streets were often built without sidewalks, residential areas were segregated from other land uses, and shopping areas were designed for access by car. These characteristics discourage walking and biking as a means of transportation, historically an important source of physical activity.
Indeed, the amount of time that adults spend walking and biking for transportation has declined in the past two decades, largely because people are driving more (Sturm, 2004). In addition, the more time that Americans spend traveling, the less time they have available for other forms of physical activity. In 2000, Americans spent nearly 26 minutes commuting to their jobs, an increase from 22 minutes in 1990, and the average commuting time was 30 minutes or more in 25 of the 245 cities with at least 100,000 population (Population Reference Bureau, 2004a).
Children's motorized vehicle travel to and from school has increased, though this represents a small proportion of their overall travel. The 2001 National Household Travel Survey (NHTS) indicated that less than 15 percent of children aged 5 to 15 years walked to or from school and 1 percent bicycled (Bureau of Transportation Statistics, 2003). Even children living relatively close to school do not walk to this destination. The 1999 HealthStyles Survey found that among participating households, 25 percent of children aged 5 to 15 years who lived within a mile of school either walked or bicycled at least once during the previous month (CDC, 2002).
From 1977 to 2001, there was a marked decline in children's walking to school as a percentage of total school trips made by 5- to 15-year-olds from 20.2 percent to 12.5 percent (Sturm, 2005b). Based on data collected through the National Personal Transportation Surveys for 1977 and 1990, and the NHTS for 2001, there is little evidence of changes in walking trip length although distance traveled by bicycle has decreased (Sturm, 2005b). Although reduced physical activity has been identified as an unintended consequence of dependence on motorized travel, it is unclear how changes in children's transportation patterns have reduced their overall physical activity levels (Sturm, 2005b).
The presence of electronic media in children's lives, and their time spent with such media, has grown considerably and has increased the time spent in sedentary pursuits, often with reduced outside play time. In 1999, the average American child lived in a home with three televisions, three radios, three tape players, two video cassette recorders (VCRs), one video game player, two compact disc players, and one computer (Roberts et al., 1999) (Figure 1-4). In 2003, nearly all children (99 percent) aged zero to six years lived in a home with a television set and the average number of VCRs or digital video discs (DVDs) in these young children's homes was 2.3 (Rideout et al., 2003). Television dominates the type of specific media used by children and youth and is the only form of electronic media for which trend data are available. In 1950, approximately 10 percent of U.S. households had a television (Putnam, 1995) in comparison with 98 percent in 1999 (Nielsen Media Research, 2000). The percent of American homes with more than one television set rose from 35 percent in 1970 (Lyle and Hoffman, 1972) to 88 percent in 1999 (Roberts et al., 1999). Moreover, there has been a ten-fold increase over the same period in the percent of American homes with three or more television sets (Rideout et al., 2003). In 2003, one-half (50 percent) of children aged zero to six years had three or more televisions, one-third (36 percent) had a television in their bedrooms, and nine out of ten children in this age range had watched television or DVDs (Rideout et al., 2003).
Daily media use among children by age. Media use includes television, video games, radios, cassette tape players, VCRs, compact disc players, and computers. SOURCE: Rideout et al., 1999. This information was reprinted with permission from the Henry J. (more...)
During a typical day, 36 percent of children watch television for one hour or less, 31 percent of children watch television for one to three hours, 16 percent watch television for three to five hours, and 17 percent watch television for more than 5 hours (Roberts et al., 1999) (Figure 1-5).
Daily television viewing by children and youth in hours. SOURCE: Rideout et al., 1999. This information was reprinted with permission from the Henry J. Kaiser Family Foundation.
Two separate national data sources have tracked children's and adolescents' discretionary time spent watching television. Results indicate that the extent of television viewing differs by age, but also suggest an observed decline in television watching by children under 12 years by approximately four hours per week between 1981 and 1997 (Hofferth and Sandberg, 2001). Based on the Monitoring the Future Survey from 1990 to 2001, there was a steady decrease in heavy television watching (three hours or more) among adolescents yet an observed increase in television viewing for one hour or less (Child Trends, 2002). Although children are using other types of electronic media including video games and computers (Roberts et al., 1999; Rideout et al., 2003), television viewing represents a significant amount of discretionary time among children and youth, which is a sedentary and modifiable activity (see Chapter 8).
Consumer Attitudes and Public Awareness
Trends in media coverage suggest a striking increase in public interest in obesity. The International Food Information Council (IFIC) has been following U.S. and international media coverage of the obesity issue since 1999 and has tracked a steady upward trend in the volume and breadth of issues covered (IFIC, 2004) (Figure 1-6).
Trends in obesity-related media coverage, 1999-2004. SOURCE: IFIC, 2004. Reprinted, with permission. Copyright 2004 by the International Food Information Council.
This media focus, independent of the longstanding popularity of weight control as a consumer issue (Serdula et al., 1999), includes obesity-related topics ranging from popular diets and quick weight loss strategies to litigation against fast food restaurants to reports of new programs, policies, and research findings.
The media coverage on obesity is viewed by the public, parents, and other stakeholder groups in a variety of ways, depending on their personal beliefs regarding issues such as personal responsibility, the role of government and other institutions in promoting personal freedoms, media influences, free speech and the rights of advertisers, and the ways in which parents should raise their children, as well as on consequent responses to various population level approaches being proposed to address obesity.
While some people place a high value on the individual's right to choose what, when, where, and how to eat and be active, others are looking for advice, information, and enhanced opportunities, and may even favor government interventions that facilitate healthier choices (Kersh and Morone, 2002).
Recent opinion polls indicate that a large number of adults and parents are very concerned or somewhat concerned about childhood obesity (Field Research Corporation, 2003; Widmeyer Polling & Research, 2003). For example, a recent telephone survey of 1,068 randomly selected California residents suggested that for one out of three respondents, obesity-related behaviors, especially unhealthy eating habits or the lack of physical activity, represent the greatest risk to California children (Field Research Corporation, 2003). Although obesity is considered a health problem comparable to smoking, some research suggests that it remains low on the list of Americans' perceptions of serious health problems, which remain dominated by cancer, HIV/AIDS, and heart disease (Oliver and Lee, 2002; Lake Snell Perry & Associates, 2003; San Jose Mercury News/Kaiser Family Foundation, 2004). More recent national research shows that Americans are perceiving childhood obesity to be a serious problem, similar to tobacco use, underage drinking, and violence, but not as serious as drug abuse (Evans et al., 2004).
Families may vary in the value they place on different health outcomes related to obesity, and the merits they attribute to certain benefits or drawbacks of changing behaviors to address it (Whitaker, 2004). Research suggests that some parents do not perceive weight, per se, to be a health issue for their children (Baughcum et al., 2000; Jain et al., 2001; Borra et al., 2003), independent of their child's physical and social functioning. They think of their child as healthy if he or she has no serious medical conditions, and they embrace the hope that the overweight child will outgrow the problem. They may also hesitate to raise weight-related issues due to their concerns that this may lower the child's self-esteem and potentially encourage him or her to develop an eating disorder. School-age children, however, do not generally view obesity as a health problem as long as it does not significantly affect appearance and performance (Borra et al., 2003). Being obese, whether as a child or an adult, is highly stigmatized and viewed as a moral failing, among some educators (Price et al., 1987), health professionals (Teachman and Brownell, 2001), and even very young children (Cramer and Steinwert, 1998; Latner and Stunkard, 2003).
Further, individuals and consumers vary in the priority they place on healthy eating and an active lifestyle, and they hold a spectrum of views on health regarding weight management, weight control, and wellness (Buchanan, 2000; Strategy One, 2003). Consumer research reveals that Americans express not having enough time to fit everything into their day that they would like to, with the consequence that their health may be neglected (Strategy One, 2003).
In a recent national poll of 1,000 U.S. adult respondents, half of the respondents viewed obesity as a public health problem that society needs to solve while the other half considered it a personal responsibility or choice that should be dealt with privately (Lake Snell Perry & Associates, 2003).
However, Americans do appear more uniformly willing to support proactive actions to reduce obesity in children and youth, especially in the school setting (Lake Snell Perry & Associates, 2003; Robert Wood Johnson Foundation, 2003; Widmeyer Polling & Research, 2003). Childhood obesity presumably engenders more support for societal-level approaches because children, who are thought to have less latitude in food and activity choices than adults, are unlikely to be blamed by society for becoming obese. Understanding consumer perceptions and knowledge of public awareness about obesity will be essential in order to design an effective multimedia and public relations campaign supporting obesity prevention (see Chapter 5).
Emerging Programs and Policies
As it has done with many other child health concerns, from whooping cough, polio, and measles to use of toddlers' seats in automobiles, the United States is now addressing the growing problem of childhood obesity. State legislatures, federal agencies, school boards, teachers, youth programs, parents, and others are mobilizing to address the array of interrelated issues associated with the development, and potential prevention, of childhood obesity. Because adult overweight and obesity rates are even higher than those of children, many efforts focus on improving eating habits and encouraging physical activity for people of all ages.
The range of these efforts is quite broad, and many innovative approaches are under way. As discussed throughout the report, many of these efforts are occurring at the grassroots level—neighborhood-specific or community-wide programs and activities encouraging healthy eating and promoting regular physical activity. A number of U.S. school districts, for instance, have established new standards for the types of food and beverages that will be available in their school systems (Prevention Institute, 2003). Many communities are examining the local availability of opportunities for physical activity and are working to expand bike paths and improve the walkability of neighborhoods. Further, community child- and youth-centered organizations (such as the Girl Scouts and the Boys and Girls Clubs of America) are adding or expanding programs focused on increasing physical activity. A national cross-sector initiative, Shaping America's Youth, supported by the private sector (industry), nonprofit organizations, and the Department of Health and Human Services, is working to compile a registry of the relevant ongoing research and intervention programs across the country as well as funding sources. Evaluating these efforts and disseminating those that are most effective will be the challenge and goal for future endeavors.
In many other countries where childhood obesity is a growing problem, including the United Kingdom, Sweden, Germany, France, Canada, and Australia, a broad array of national and community-level efforts and policy options are being pursued. Among these are the banning of vending machines in schools, developing restrictions for television advertising to children, and using taxes derived from energy-dense foods to support physical activity programs.